BBGH DIALYSIS APPROACHES 10TH ANNIVERSARY (With Audio)

One of the great success stories of Box Butte General Hospital (BBGH) and the residents of the area it serves is the hospital Dialysis Unit. The first patient treated at the unit was in December of 2000, meaning in just a few months it will be the 10th anniversary of the opening of its doors to serve the community of patients it was designed for.

An interview on KCOW Radio in 2003 with former CEO Terry Padden, now deceased, provides the reader with a firsthand account of how the Unit came to be, and how local enthusiasm and commitment from the public overcame the opinions of medical industry experts that a dialysis treatment center at BBGH was not feasible, or only marginally so in the best of circumstances.

"I'll never forget Bud Roes, from Hemingford, coming into my office, by himself, asking us to do it," Mr. Padden related. Marie Roes, Bud's wife, was a dialysis patient at the time, having to travel to Scottsbluff for her three times per week treatment. Regional West Medical Center was the closest dialysis treatment center. "I told him what I always tell people: We are the community's hospital. We know how to do it, and know how to put the program in. But ... we have to know it is what the community wants."

He said Mr. Roes immediately went to the Extension Clubs of the county, which put their wholehearted support behind the concept by immediately announcing that all the proceeds from a fashion show they were sponsoring would go to the establishment of a dialysis unit at BBGH. "I always have fun telling the story of what happened next," Mr. Padden continued. "The Extension Clubs announcement was before I had a chance to have the Trustees of the hospital review the project. I'll never forget that it was Arnie Kuhn, who was Chairman at that time, who called me. The phone rings and Arnie asks, 'Terry what are you doing?' And I asked back, 'What do you mean?' Arnie said, 'Well, I hear there's a fund raiser for the Dialysis project.' I replied, 'Yeah, isn't that cool!' And Arnie said, "Yeah, well it would help if the board approved it, don't you think?"

Another indication of why there was a need for a dialysis service in the county is a poignant story related in 1999 by former KCOW Radio manager Mike Garwood, also now deceased. He said the station decided that a big band dance being sponsored by the radio station in celebration of its 50th anniversary would have all of the free will offerings it garnered donated to the county's Extension Clubs to help them in their effort to raise funds for a new dialysis unit. "We had a news director at KCOW named Jim Shull," Mr. Garwood related in the 1999 interview. "Jim was diabetic, and his health situation deteriorated to the point where he needed to travel to Scottsbluff three days a week for dialysis treatment." Mr. Garwood said the treatments were strenuous enough, but that the 120 mile round trip to Scottsbluff three days a week significantly added to Mr. Shull's burden. That took an even greater toll that eventually resulted in his resigning from KCOW so that he could move to Scottsbluff to be nearer to the treatment center. "Jim was eventually able to receive a new kidney via a transplant," he said. "But the hardship he went through in making those trips to Scottsbluff three times a week certainly brought home to us why we should help with the fund raising effort for a treatment center at BBGH."

That enthusiasm, and the successful fund raising efforts to make the Unit a reality, overrode any concerns raised by professional planners that such a service would be only marginal at best, serving no more than four to five patients at peak use. "The professionals may have thought it wasn't doable," Mr. Padden concluded in his 2003 interview, "but we did. We soon had thirteen patients in the program."

Nearly 10 years later, the Dialysis Unit is averaging 20 patients treated each week, with the current census at 18, according to Paulette Burkhardt, RN, Manager of the Dialysis Unit. After receiving her RN credentialing 10 years ago she spent the next nine in dialysis, with the last two as Manager at the Unit. "I became interested in working in dialysis because my mother was a dialysis patient, so I had that personal connection," she said. "After I started working at a dialysis center, I fell in love with the fact that you really spend a lot of time together with the patients. They know our children, we know their children. It's great."

She said the Unit has a capacity of treating 24 patients per week. "We've treated about 50 individuals here over those years, doing around 2,900 treatments per year, with each treatment three to four hours, Ms. Burkhardt said. "We keep busy." To give a perspective, that is approximately 10,150 hours of treatment given a year, or 422 days.

It takes a well integrated staff to constantly be considered one of the best dialysis service units in Nebraska. "We have a very dedicated staff, all of whom work well together," Ms. Burkhardt said.

According to Ms. Burkhardt, "The hemodialysis treatment option at the Unit is for End Stage Renal Disease. Hemodialysis is simply osmosis/diffusion. We pull blood from the patient via the patient's vascular access. The blood flows through the tubing with the help of a pump in the dialysis machien and runs through a filter. At the same time what we call the dialysate runs against the filter. The dialysate is prescribed by the physician for each individual. Then the osmosis/diffusion process removes the toxins and excess fluid and the clean blood is returned to the patient. This process is repeated over and over during the 3-4 hour treatment."

One staff member is Ben Andrick, RN. Mr. Andrick explained how the Unit obtains the extra pure water it needs during for the treatment of their patients. "We receive our water from the City of Alliance and while it is fine for drinking, it isn't pure enough to run through our machines for our patients," he said. "We run the water through a series of filters. We start with a multi-media filter which disposes of particulate matter. Then we run it through a water softener that adjusts the PH. From there it goes through carbon tanks that take out all the chlorine the City puts in the water to get rid of bacteria. Then it goes through an ultra filter, or reverse-osmosis filter. When it comes out, it is basically very pure water." He said the staff runs tests on the water three times a day to make sure the water meets the high standards needed for dialysis.

Beth Bates has been an LPN fourteen years, with the last two in the Dialysis Unit. Another staff member, Cindy Vela, has been an LPN for five years, spending the last year working dialysis at BBGH. They discussed the stringent fluid requirements dialysis patients need to adhere to. "Dialysis patients are on dialysis because their kidney's don't work properly any more, which means fluid builds up in their bodies, getting stored in their body tissues," Ms. Bates said. "It's amazing how one of our patients can come in with a swollen face because of fluid buildup, but after treatment, their face is thin again."

Her counterpart, Ms. Vela, said patients are asked to restrict fluid intact to just one liter per day. "That's equivalent to an IV bag, or maybe, say, three cans of soda pop per day," she said. "That isn't just liquid that you would normally think of, like water or pop. It also includes foods, like watermelon, or any food that can turn to liquid at room temperature, such as ice cream. They really have to watch what they are doing all the time." That means the usual advice to consume as much liquid as possible on very hot days has to be disregarded by dialysis patients. "We urge them to maybe use ice chips, frozen grapes and such, or chew gum to keep their mouth hydrated. It is a gradual intake, so that they keep hydrated but not go over their limit."

The overall medical supervisor of the Unit is Dr. Eric Wiebe of Scottsbluff, who reviews and visits the Unit at least one week per month. Sandhills Family Center Physician Assistant Jerre Mount is at the Unit three weeks out of the month, conferring with Dr. Wiebe about the day-to-day treatment needs of the Unit's patients. She said she became involved with dialysis approximately five years ago when Dr. Ray Carlson was the physician supervisor of the Dialysis Unit. "I make the rounds, and keep track of labs and how their runs go generally," she said. "If there are any questions or problems, I'll confer with Dr. Wiebe.

"The most important fact about kidney disease or failure is that you can't see it, you can't feel it," Ms. Mount continued. "So it is very important that ... especially if you have high blood pressure, diabetes, or cholesterol issues ... that you meet with your provider and get screened at least annually, by both microalbumin (urine) and creatinine (blood) tests. If you find any signs of kidney disease, it's recommended that you ask to see a kidney provider, such as Dr. Wiebe or myself."

Once kidney disease sets in and function begins to fail, the damage incurred cannot be reversed, so it is very important to take preventative measures early by eating right, daily exercise and addressing high blood pressure or cholesterol issues that may develop. "Once your kidneys do start to fail, it is important to see your kidney provider regularly," Ms. Mount said. "Keep seeing your usual provider, of course, but there are certain things we monitor so that if you do need to go on to dialysis, we have everything in place." Five top issues that progress renal failure more rapidly are diabetes, high blood pressure, elevated cholesterol, smoking and obesity.

She said those individuals diagnosed with kidney failure should avoid any intake of aluminum and magnesium. Aluminum is used in antacids and magnesium in laxatives. Blood pressure medicine should be monitored because of blood pressure issues that arise from kidney failure. Anti-inflammatory drugs such as Advil and Aleve can cause problems for kidneys, and salt intake should be restricted.

Mrs. Mount said there are a number of considerations that patients in the late stages of renal failure can consider. "In the late stages of kidney disease, there are a lot of considerations of what to do as far as different kinds of dialysis," she said. "There is peritoneal dialysis or home hemodialysis, either one of which can be done at home. Then you have the regular hemodialysis which is given in the Unit."

The Unit also helps get people on transplant waiting lists. "We try to get people on the waiting list as soon as it looks like they're going into the final stages of renal failure," Ms. Mount said. "The waiting list for transplants is about four years in this area. Of course, we'd rather get you transplanted before you get to dialysis, but that isn't always possible." She stressed again how important it is that area residents have their primary providers conduct yearly kidney screenings, both urine and blood.

LPN Cari Krauter has been with the Unit for the past eight years. She focused her interview on vascular access surgical procedures, which dialysis patients need to have performed in order to be treated. "Vascular access is created during surgery, where an artery and vein are sown together. This causes the veins to enlarge. That way the dialysis staff can easily place two needles and get the patients hooked up to the machine." She said the amount of blood being circulated during dialysis is significant, which is another important reason the procedure is needed.

There are three types of vascular access for hemodialysis: arteriovenous (AV) fistula; AV graft; and a venous catheter.

An AV fistula is useful because it causes the vein to grow larger and stronger for easy access to the blood system. The AV fistula is considered the best long-term vascular access for hemodialysis because it provides adequate blood flow, lasts a long time, and has a lower complication rate than other types of access. If an AV fistula cannot be created, an AV graft or venous catheter may be needed. "An AV graft is used when the patient has veins that are too small for aAV fistula," Ms. Krauter said. "In some cases, a catheter might be needed, though they are usually temporary, being used when a patient needs dialysis sooner than normal." She said all three access types need to be protected and kept clean.

Tonya Sanders, RN, has been with the Unit for nine years and helps patients process their transplant requests. "I help take them through the process," she said. "Many times they've already contacted the transplant center of their choice and gone through the process. But most don't. We use a program that was developed by Heartland Kidney Network, which is the organization we use. It's called Explore Transplant." Four meetings are held with the patient, discussing what transplants are, their risks and benefits. "By the end of those meetings, hopefully they are able to make a choice," Ms. Sanders said. "If they decide on a transplant, we will put them in contact with a transplant facility."

Tonya added a list of statistics that illustrate how important it is for patients who choose transplants to get on a list as soon as possible, as well as how important it is for people to designate themselves as organ transplant donors (usually by checking the corresponding box on individual drivers licenses). "There are about 105,000 patients in the country currently waiting for an organ transplant, and more than 4,000 are added to the waiting list each month," she said. "This is not only for kidney transplants, but also heart and liver. Every day, 18 people die while waiting for a transplant of a vital organ. Because of a lack of available donors, 4,573 kidney patients died in 2008 while waiting for a life saving kidney from a donor. And yes, I'm a donor."

Ms. Burkhardt wrapped up the interview by saying, "Right now there are 26 million Americans who have chronic kidney disease, with one in six Nebraskans at risk for kidney disease. There will always be a need for dialysis. Once damaged, the kidney is unable to repair itself. It's a progressive disease and no one knows how fast it will progress individually. It's only when it gets to 25 percent to 30 percent function that you might start seeing physical clues that something is going on --- such as high blood pressure, having to go to the bathroom more often at night, swollen ankles and such. And just because a person is still able to make urine does not mean they do not have kidney disease."

She said those facts alone should bring home to area residents how important it is to ask their provider for annual kidney screening tests.  "I can’t stress that enough," she concluded.

The nursing staff of the BBGH Dialysis Unit: Front, l-r - Ben Andrick, RN; Dialysis Unit Manager Paulette Burkhardt, RN, CDN; Tonya Sanders, RN, CDN; Beth Bates, LPN. Back row, l-r - Cari Krauter, LPN; Cindy Vela, LPN; Gail Molyneaux, RN, CNN; Virginia Campbell, LPN, recently retired.

Click on the icons below to access audio of late BBGH CEO Terry Padden (from 2003) and late KCOW Manager Mike Garwood (from 1999).